Background: Deaths caused by drug overdose continue to be a public health crisis and contribute to overall mortality and the lowering of life expectancy in the United States. In 2021, the number of drug overdose deaths surged to nearly 107,000 nationally and more than 5,800 in New York State (NYS). Little is known about the relationship between county-level health factors and drug overdose outcomes in NYS. Therefore, we aim to evaluate the association of drug overdose mortality, emergency department (ED) visit, and hospitalization rates with county health disparity in NYS.

Methods: We examined county-level drug overdose mortality, ED visits, and hospitalization rates in 2019 from the New York State Department of Health (NYSDOH). County Health Rankings (CHR) is a comprehensive assessment using weighted measures in 4 different categories (30% Health Behaviors, 20% Clinical Care, 40% Social and Economic Factors, and 10% Physical Environment) to provide a summary z-score for each county and determine county health rankings in the state. We obtained 2021 NYS county health factors z-score from CHR, which includes survey data for 2015-2019. Negative binomial regression was used to analyze the association between county health factors z-score as assessed by CHR and drug overdose outcomes in NYS.

Results: In 2019, drug overdose age-adjusted mortality, ED visit, and hospitalization rates per 100,000 population were 18.3, 178.8 and 71.2, respectively. Among 62 counties, Nassau had the lowest z-score (the healthiest county) whereas Bronx had the highest z-score (the least healthy county) for Overall health factors. Mortality rates ranged from 2.5/100,000 in St. Lawrence to 43.3/100,000 in Sullivan. ED visit rates ranged from 97.9/100,000 in Schoharie to 343.8/100,000 in Chemung. Hospitalization rates ranged from 20.7/100,000 in Essex to 156.8/100,000 in Bronx. Our study showed counties with higher z-score of Overall health factors were significantly associated with greater ED visit (Rate Ratio [RR]: 1.019 [95%CI: 1.005-1.034], per 0.1-unit increase) and hospitalization rates (1.020 [1.006-1.034]). Regarding 4 categories, ED visit and hospitalization rates were also significantly greater in counties with higher z-score of Health Behaviors (1.065 [1.030-1.101]) and Social and Economic Factors (1.037 [1.010-1.065]), respectively. However, there was no association between county health factors and drug overdose mortality in NYS.

Conclusions: There are remarkable variations in drug overdose outcomes among NYS counties. Drug overdose ED visit and hospitalization rates were strongly associated with county health disparities. These findings suggest additional health resources should be allocated to areas with health disadvantages to improve inequitable outcomes of drug overdose.

IMAGE 1: Figure 1. Maps of County Health Factors and Drug Overdose Outcomes in New York State

IMAGE 2: Table 1. Association of Drug Overdose Outcomes with County Health Rankings in New York State